Management of Autoimmune Skin Diseases — MCQs
What is the primary condition for which calcitriol is used as a treatment?
A 85-year-old female developed multiple blisters on the trunk and thighs. Nikolsky's sign is negative. The lesions came on and off. The most probable diagnosis is
Steroids are used in the Rx of the following diseases EXCEPT:
Assertion: Vitamin D analogues are effective in psoriasis. Reason: They reduce keratinocyte proliferation
Dapsone is NOT used in:
Acute febrile neutrophilic dermatosis is seen in-
A 26-year-old female patient presented with oral ulcers, sensitivity to light and rash over the malar area of the face sparing the nasolabial folds of both sides. Which of the following is most characteristic of this condition?
Identify the lesion:
Most common indication of liver transplantation in children is:
Lady presents with joint pain in both knees and low-grade fever, which occurs intermittently. On examination, she has a rash on sun-exposed areas. What is the clinical diagnosis?
Management of Autoimmune Skin Diseases Indian Medical PG Practice Questions and MCQs
Question 1: What is the primary condition for which calcitriol is used as a treatment?
- A. Pemphigus
- B. Secondary hyperparathyroidism (Correct Answer)
- C. Lichen planus
- D. Leprosy
Explanation: Secondary hyperparathyroidism - Calcitriol is the active form of vitamin D (1,25-dihydroxyvitamin D₃), and it is crucial for regulating calcium and phosphate levels in the body [1]. - In secondary hyperparathyroidism, often seen in chronic kidney disease (CKD), the kidneys cannot convert vitamin D to its active form, leading to hypocalcemia and increased PTH secretion [1], [2]. - Calcitriol supplementation helps to increase calcium absorption from the gut and suppress the release of parathyroid hormone (PTH), thereby treating the underlying cause of secondary hyperparathyroidism [1], [2]. - This is the primary therapeutic indication for calcitriol in clinical practice. Lichen planus - This is a chronic inflammatory condition affecting the skin, hair, nails, and mucous membranes - Typically treated with corticosteroids or other immunosuppressants - Calcitriol has no primary role in the treatment of lichen planus; its therapeutic applications are predominantly related to calcium and bone metabolism Pemphigus - Pemphigus is a group of rare autoimmune blistering diseases that affect the skin and mucous membranes - Primary treatment involves immunosuppressants like corticosteroids, often in high doses - Calcitriol is not indicated for the treatment of pemphigus, as its mechanism of action is unrelated to the autoimmune processes characteristic of this disease Leprosy - Leprosy is a chronic infectious disease caused by the bacterium Mycobacterium leprae - Treated with multi-drug therapy (MDT), which includes antibiotics like rifampicin, dapsone, and clofazimine - Calcitriol is not an antibiotic and therefore has no role in treating the bacterial infection responsible for leprosy
Question 2: A 85-year-old female developed multiple blisters on the trunk and thighs. Nikolsky's sign is negative. The lesions came on and off. The most probable diagnosis is
- A. Pemphigus vulgaris
- B. Bullous pemphigoid (Correct Answer)
- C. Lepra reaction
- D. Lichen planus
Explanation: ***Bullous pemphigoid*** - The presence of **multiple tense blisters** on the trunk and thighs in an 85-year-old female, coupled with a **negative Nikolsky's sign**, is highly characteristic of bullous pemphigoid. - This condition tends to wax and wane, causing the lesions to "come on and off," and is more common in the **elderly**. *Lichen planus* - This condition presents with **pruritic, polygonal, purple, planar papules and plaques**, not blisters. - It does not typically involve the formation of **blisters** as the primary lesion nor does it involve a negative Nikolsky's sign. *Pemphigus vulgaris* - Characterized by **flaccid blisters** that rupture easily, leading to erosions, and a **positive Nikolsky's sign**. - This is in contrast to the **tense blisters** and **negative Nikolsky's sign** described in the patient. *Lepra reaction* - Refers to **acute inflammatory episodes** occurring in patients with leprosy, often presenting as **erythematous nodules** or plaques. - It does not typically involve the formation of **blisters** on the trunk and thighs in an elderly patient without a prior diagnosis of leprosy.
Question 3: Steroids are used in the Rx of the following diseases EXCEPT:
- A. Pemphigus vulgaris
- B. Chronic fungal infection (Correct Answer)
- C. Erythema multiforme
- D. Contact dermatitis
Explanation: ***Chronic fungal infection*** - **Steroids are absolutely contraindicated** in **chronic fungal infections** as they **suppress cell-mediated immunity**, leading to worsening of the infection and potential dissemination. - Corticosteroids promote fungal growth and can convert a localized infection into a systemic, life-threatening condition. - This is the **clearest contraindication** among the options. *Pemphigus vulgaris* - **Pemphigus vulgaris** is an **autoimmune blistering disease** where **high-dose systemic steroids are the first-line treatment**. - Corticosteroids (1-2 mg/kg/day of prednisolone) are essential for controlling autoantibody production and preventing life-threatening complications. - **Steroids are clearly indicated**, not contraindicated. *Erythema multiforme* - **Erythema multiforme** is typically a **self-limiting condition** managed primarily with **supportive care** (antipyretics, antihistamines, topical care). - **Systemic steroids are generally NOT recommended** as standard treatment and their use remains **controversial**. - However, in very rare severe cases with extensive mucosal involvement, some clinicians may consider a short course, making this **not an absolute contraindication** like fungal infections. *Contact dermatitis* - **Contact dermatitis** is commonly treated with **topical corticosteroids** as first-line therapy to reduce inflammation and pruritus. - In severe, widespread cases, a short course of **oral steroids** may be prescribed. - **Steroids are clearly indicated** for this condition.
Question 4: Assertion: Vitamin D analogues are effective in psoriasis. Reason: They reduce keratinocyte proliferation
- A. Both A & R true, R explains A (Correct Answer)
- B. A false R true
- C. Both A & R true, R doesn't explain A
- D. A true R false
Explanation: ***Both A & R true, R explains A*** - **Vitamin D analogues** (e.g., calcipotriol) are a cornerstone treatment for psoriasis because they effectively modulate **keratinocyte proliferation** and differentiation. - Psoriasis is characterized by the **rapid overgrowth of keratinocytes**, and the antiproliferative effects of vitamin D analogues directly address this pathological hallmark. *A false R true* - This option is incorrect because both the assertion (Vitamin D analogues are effective in psoriasis) and the reason (They reduce keratinocyte proliferation) are individually true. - The effectiveness of vitamin D analogues in treating psoriasis is well-established in dermatological practice. *Both A & R true, R doesn't explain A* - This option is incorrect because the reduction of keratinocyte proliferation is precisely *how* vitamin D analogues exert their therapeutic effect in psoriasis. - The mechanism of action described in the reason directly explains the efficacy mentioned in the assertion. *A true R false* - This option is incorrect because the reason ("They reduce keratinocyte proliferation") is a fundamental and well-understood mechanism by which vitamin D analogues work in psoriasis. - Vitamin D analogues bind to vitamin D receptors in keratinocytes, influencing gene expression to inhibit their excessive growth.
Question 5: Dapsone is NOT used in:
- A. Dermatitis herpetiformis
- B. Alopecia areata (Correct Answer)
- C. Pneumocystis jirovecii pneumonia prophylaxis
- D. Leprosy
Explanation: ***Alopecia areata*** - **Dapsone** is an **antibiotic** with anti-inflammatory and immunomodulatory properties and is not indicated for the treatment of **alopecia areata**. - Treatment for **alopecia areata** typically involves **corticosteroids** (topical, intralesional, or systemic) or other immunosuppressants. *Dermatitis herpetiformis* - **Dapsone** is the **first-line treatment** for **dermatitis herpetiformis** due to its rapid antipruritic effect, often providing relief within 24-48 hours. - It works by reducing the inflammation and formation of the characteristic **subepidermal blisters** seen in this condition. *Pneumocystis jirovecii pneumonia prophylaxis* - **Dapsone** is an effective **alternative agent** for prophylaxis against **Pneumocystis jirovecii pneumonia (PCP)**, especially in patients who cannot tolerate trimethoprim-sulfamethoxazole. - It is often used in combination with **pyrimethamine** for toxoplasmosis prophylaxis in HIV-infected patients. *Leprosy* - **Dapsone** is a crucial component of **multidrug therapy (MDT)** for both paucibacillary and multibacillary forms of **leprosy**. - It acts as a **bacteriostatic agent** against Mycobacterium leprae and has been a cornerstone of leprosy treatment for decades.
Question 6: Acute febrile neutrophilic dermatosis is seen in-
- A. Behcet's syndrome
- B. Sweet syndrome (Correct Answer)
- C. Haberman syndrome
- D. Kasabach-Merritt syndrome
Explanation: ***Sweet syndrome*** - Sweet syndrome is also known as **Acute febrile neutrophilic dermatosis**. - It presents with **fever**, painful erythematous plaques, and a prominent **neutrophilic infiltrate** in the dermis. *Behcet's syndrome* - Behcet's syndrome is characterized by **recurrent oral and genital ulcers**, uveitis, and skin lesions like **erythema nodosum** or **pathergy**. - It is a systemic vasculitis, not typically presenting as acute febrile neutrophilic dermatosis. *Haberman syndrome* - Haberman syndrome is better known as **Pityriasis lichenoides et varioliformis acuta (PLEVA)**. - It is a rare skin condition characterized by an acute eruption of **papules** and **erosions** that can resemble **chickenpox**. *Kasabach-Merritt syndrome* - This syndrome is a rare disorder involving **vascular tumors** (e.g., hemangiomas) that lead to profound **thrombocytopenia** and **consumptive coagulopathy**. - It does not present with acute febrile neutrophilic dermatosis.
Question 7: A 26-year-old female patient presented with oral ulcers, sensitivity to light and rash over the malar area of the face sparing the nasolabial folds of both sides. Which of the following is most characteristic of this condition?
- A. Butterfly rash sparing the nasolabial folds (Correct Answer)
- B. Heliotrope rash on upper eyelid, bilateral hilar lymphadenopathy
- C. Port-wine stain with CNS malformations
- D. Silvery scales or plaques
Explanation: ***Butterfly rash sparing the nasolabial folds*** - The patient's presentation with oral ulcers, sensitivity to light (photosensitivity), and a rash over the malar area **sparing the nasolabial folds** is highly characteristic of **Systemic Lupus Erythematosus (SLE)**, a condition where a butterfly rash is a hallmark. - This specific distribution of the malar rash is a key diagnostic feature differentiating it from other facial rashes. *Heliotrope rash on upper eyelid, bilateral hilar lymphadenopathy* - A **heliotrope rash** on the upper eyelids is characteristic of **dermatomyositis**, which also presents with muscle weakness, not typically oral ulcers or a malar rash. - **Bilateral hilar lymphadenopathy** is a classic finding in **sarcoidosis**, a granulomatous disease, not directly related to the patient's symptoms. *Port-wine stain, CNS malformations: seen in Sturge-Weber syndrome* - A **port-wine stain** (nevus flammeus) is a congenital capillary malformation, often on the face, and is a principal feature of **Sturge-Weber syndrome**, which involves CNS malformations and seizures. - This condition has no association with oral ulcers, photosensitivity, or the described malar rash. *Silvery scales or plaques: seen in psoriasis* - **Silvery scales or plaques** are the characteristic dermatological lesions of **psoriasis**, a chronic inflammatory skin condition. - Psoriasis typically presents with well-demarcated erythematous plaques and is not associated with oral ulcers, photosensitivity, or a lupus-specific malar rash.
Question 8: Identify the lesion:
- A. Psoriasis
- B. Dermatitis herpetiformis
- C. Erythema marginatum
- D. Dermatomyositis (Correct Answer)
Explanation: ***Dermatomyositis*** - The image shows **Gottron's papules** over the extensor surfaces of the elbows, which are characteristic of dermatomyositis. These are violaceous, erythematous, flat-topped papules. - While typically found on the **dorsum of the hands** over the MCP and IP joints, they can also occur on elbows, knees, and ankles. *Psoriasis* - Psoriasis typically presents with **well-demarcated erythematous plaques** covered with silvery scales, especially on extensor surfaces. - The lesions in the image lack the characteristic **silvery scaling** of psoriasis. *Dermatitis herpetiformis* - This condition presents with intensely **itchy, polymorphic lesions**, including vesicles, bullae, and excoriations, arranged in a symmetrical fashion, often on extensor surfaces. - The lesions in the image are papular and nodular, not exhibiting the characteristic **vesicular or bullous eruption** of dermatitis herpetiformis. *Erythema marginatum* - Erythema marginatum is a **transient, non-pruritic erythematous rash** with serpiginous borders and central clearing, typically seen in **acute rheumatic fever**. - The lesions in the image are fixed papules/nodules without the characteristic migrating or rapidly changing appearance of erythema marginatum.
Question 9: Most common indication of liver transplantation in children is:
- A. Biliary atresia (Correct Answer)
- B. Wilson's disease
- C. Hemochromatosis
- D. Primary biliary cirrhosis
Explanation: ***Biliary atresia*** - **Biliary atresia** is the leading cause of chronic liver disease and liver transplant in children, accounting for approximately **50% of all pediatric liver transplants**. - It involves progressive **fibrosis and obliteration of the bile ducts**, leading to cholestasis, cirrhosis, and liver failure in infancy. *Wilson's disease* - While Wilson's disease can lead to liver failure requiring transplant, it is a **less common indication** than biliary atresia in children. - It is a genetic disorder of **copper metabolism**, leading to copper accumulation in various organs. *Hemochromatosis* - **Hemochromatosis** is a disorder of **iron overload** that can cause liver damage and cirrhosis. - However, it is a **rare indication for liver transplant in childhood** compared to biliary atresia. *Primary biliary cirrhosis* - **Primary biliary cirrhosis (PBC)** is an autoimmune disease primarily affecting **small bile ducts** in the liver. - PBC predominantly affects **adults, especially women**, and is a very rare cause of liver failure in children.
Question 10: Lady presents with joint pain in both knees and low-grade fever, which occurs intermittently. On examination, she has a rash on sun-exposed areas. What is the clinical diagnosis?
- A. Systemic lupus erythematosus (SLE) (Correct Answer)
- B. Rheumatoid arthritis (RA)
- C. Photodermatitis
- D. Porphyria cutanea tarda
Explanation: ***Systemic lupus erythematosus (SLE)*** - The combination of **polyarthralgia (joint pain)**, **low-grade fever**, and a **photosensitive rash** is highly characteristic of SLE. [1] - SLE is a **multisystem autoimmune disease** that can affect joints, skin, and cause constitutional symptoms like fever. [1] *Rheumatoid arthritis (RA)* - While RA causes **joint pain**, it typically presents with **symmetrical polyarthritis** primarily affecting small joints, and a photosensitive rash is not a common feature. [2] - **Fever** can be present in severe RA, but the triad of symptoms in this case points away from RA as the primary diagnosis. *Photodermatitis* - **Photodermatitis** is a skin inflammation caused by sunlight exposure, resulting in a rash. - This diagnosis does not account for the **joint pain** or **low-grade fever**, which are systemic manifestations. *Porphyria cutanea tarda* - This condition primarily affects the skin, causing **photosensitivity**, blistering lesions, and increased fragility, especially on sun-exposed areas. - It does **not typically present with joint pain or fever**, differentiating it from the presented symptoms.
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